Senate Finance Committee Issues Report on Activities of Committee During 117th Congress (Part 3 of 7)

WASHINGTON, April 11 -- The Senate Finance Committee issued a report (S.Rpt. 118-4) on the review of the activities of the committee during the 117th Congress pursuant to Rule XXVI of the Standing Rules of the Senate. The report was advanced by Sen. Ron Wyden, D-Oregon, on March 28, 2023.

(Continued from Part 2 of 7)

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HEALTH

SUMMARY OF ACTIVITIES

In the 117th Congress, the committee focused on improving Medicare, Medicaid, and Children's Health Insurance Program (CHIP) for individuals, providers, and taxpayers.

In March of 2021, the chairman authored several provisions that were included in the American Rescue Plan Act of 2021, which was passed by Congress and signed into law by the President. The health provisions expanded premium tax credits for 2 years in the health insurance marketplaces, established a State option to provide 12 months of Medicaid and CHIP coverage during the postpartum period, required coverage of COVID-19 vaccines and treatment under Medicaid and CHIP, provided enhanced funding for Medicaid home and community-based services, established a State option in Medicaid to provide temporary enhanced funding for mobile crisis services, and provided grant funding for new and existing Elder Justice Act (EJA) programs that are aimed at protecting seniors and people with disabilities who reside in nursing homes.

In August of 2021, the committee embarked on a bipartisan effort following hearings earlier in the year to improve access to mental health-care services in Medicare, Medicaid, and CHIP. The committee released a Request for Information (RFI) to stakeholders and the public to gather information on proposals in five distinct policy areas that would be considered for a bipartisan legislative package. The five policy areas included: (1) behavioral health-care workforce, (2) primary care and behavioral health-care integration, (3) tele-mental health care, (4) youth mental health, and (5) behavioral and physical health-care parity. The committee designated 10 bipartisan Finance Committee members to lead the development of legislation in each of these policy areas.

In March of 2022, the committee released a bipartisan report titled "Mental Health Care in the United States: The Case for Federal Action" that describes the state of mental health care in the Medicare and Medicaid programs and potential policy interventions based on information gathered from experts and stakeholders who testified at committee hearings and provided responses to the committee's RFI. Beginning in May of 2022 and concluding in December of 2022, the committee released bipartisan discussion drafts containing policy proposals to address mental health care for each of the five identified subject areas. Through this bipartisan process, the committee authored several provisions related to improving access to mental health-care services in Medicaid and CHIP which were included in the Bipartisan Safer Communities Act of 2022 that was passed by Congress and signed into law by the President in June of 2022. The policies include an extension and nationwide expansion of the Certified Community Behavioral Health Clinic (CCBHC) demonstration program, increased access to Medicaid tele-mental health services, support for Medicaid/CHIP funding for mental health services in schools, and improved oversight and enforcement of Medicaid's early and periodic screening, diagnostic, and treatment benefit, which provides comprehensive health coverage to children.

Several more of the committee's mental health provisions were signed into law as a part of the Consolidated Appropriations Act, 2023 (CAA 2023). With respect to Medicare, these provisions included providing Medicare coverage of marriage and family therapist services and mental health counselor services, improving Medicare payment for mobile crisis services, providing additional medical residency slots for psychiatry specialties and other specialties in Medicare's graduate medical education (GME) program, and providing flexibility under Medicare's program integrity laws to allow for hospitals to provide mental health wellness programs to physicians and other clinicians. With respect to Medicaid and CHIP, the provisions will strengthen requirements on health plans and State Medicaid programs to publish updated directories of the providers in their networks, including mental health providers, improve access to mental health and substance use disorder services for justice-involved youth, and provide States with additional guidance to build out their crisis care continuums.

The committee also worked on a bipartisan basis to extend flexibilities and expiring authorities in the Medicare and Medicaid programs by authoring provisions in continuing resolutions to fund the government. This includes the Consolidated Appropriations Act, 2022. Examples of health provisions in this bill include the extension of telehealth flexibilities beyond the end of the COVID-19 public health emergency and the extension of Medicaid funding for U.S. territories.

In December of 2022, as a part of CAA 2023, the committee authored a number of bipartisan health provisions beyond mental health care under Medicare and Medicaid that were signed into law. Examples include extension of expiring Medicare payment policies for hospitals, as well as the provision of Medicare coverage of compression garments for treatment of lymphedema, coverage under Medicare Part D for COVID-19 treatment medications that were authorized by the Food and Drug Administration (FDA) under emergency use authorization, and a transition of Medicare's Intravenous Immune Globulin (IVIG) demonstration to a permanent benefit.

The CAA 2023 also included significant improvements in Medicaid and CHIP coverage authored by the committee, such as a permanent requirement for States to provide 12 months of continuous eligibility for children in Medicaid/CHIP; a permanent extension of the State option to provide 12 months of Medicaid/CHIP coverage for postpartum women; a 2-year extension of funding for CHIP through fiscal year 2025; a 4-year extension of the Money Follows the Person program and spousal impoverishment protections, which help seniors and individuals with disabilities access home and community-based care, through fiscal year 2027; and a long-term extension of Medicaid funding for the U.S. territories, including 5 years of funding for Puerto Rico and permanent funding for the other territories. In addition, the CAA 2023 provided funding and guard rails to support State Medicaid programs' transition from COVID-19 public health emergency requirements beginning in April 2023.

The chairman led an effort to reduce the cost of prescription drugs in the Medicare program and authored several provisions included in the Inflation Reduction Act of 2022, which was passed by Congress and signed into law by the President in August of 2022. These provisions authorize the Medicare program to negotiate program payment for certain prescription drugs under the Part B and Part D programs, cap the beneficiary monthly out-of-pocket cost of insulin prescribed under Part B and Part D, cap the beneficiary total annual out-of-pocket cost for prescription drugs covered under Medicare Part D, and provide recommended vaccines for seniors under Medicare and all Medicaid and CHIP beneficiaries at no out-of-pocket cost.

In November of 2022, the chairman released a report titled "Deceptive Marketing Practices Flourish in Medicare Advantage," which investigated the marketing practices of Medicare Advantage plans. This investigation was in response to concerns raised by State insurance commissioners, insurers, and Medicare beneficiaries. This report summarized information on marketing practices from fourteen different States and provided recommendations to the Centers for Medicare and Medicaid Services on regulatory actions to protect beneficiaries from misleading marketing.

Full Committee Hearings

2021

May 19, 2021--"COVID-19 Health Care Flexibilities:

Perspectives, Experiences, and Lessons Learned." Testimony was heard from Jessica Farb, Director, Health Care, Government Accountability Office, Washington, DC; Kisha Davis, M.D., MPH, FAAFP, member, Commission on Federal and State Policy, American Academy of Family Physicians, Leawood, KS; Linda V. DeCherrie, M.D., clinical director, Mount Sinai at Home, and professor of geriatrics and palliative medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY; Narayana Murali, M.D., board member, America's Physician Groups, and executive director, Marshfield Clinic, Marshfield, WI; and Robert A. Berenson, M.D., institute fellow, Urban Institute, Washington, DC.

June 10, 2021--"The President's Fiscal Year 2022 HHS Budget." Testimony was heard from Hon. Xavier Becerra, Secretary, Department of Health and Human Services, Washington, DC.

June 15, 2021--"Mental Health Care in America: Addressing Root Causes and Identifying Policy Solutions." Testimony was heard from Benjamin F. Miller, PsyD, chief strategy officer, Well Being Trust, Oakland, CA; Chantay Jett, MA, MFT, executive director, Wallowa Valley Center for Wellness, Enterprise, OR; Michelle P. Durham, M.D., MPH, FAPA, DFAACAP, assistant professor of psychiatry, Boston University School of Medicine, and vice chair of education and psychiatry residency training director, Department of Psychiatry, Boston Medical Center, Boston, MA; and Thomas Betlach, MPA, partner, Speire Healthcare Strategies, Phoenix, AZ.

October 20, 2021--"Health Insurance Coverage in America: Current and Future Role of Federal Programs." Testimony was heard from Hon. Rick Scott, a U.S. Senator from Florida; Hon. Raphael Warnock, a U.S. Senator from Georgia; Frederick Isasi, J.D., MPH, executive director, Families USA, Washington, DC; Douglas Holtz-Eakin, Ph.D., president, American Action Forum, Washington, DC; Sara R. Collins, Ph.D., vice president for health care coverage and access, The Commonwealth Fund, New York, NY; and Linda J. Blumberg, Ph.D., institute fellow, Urban Institute, Washington, DC.

2022

February 8, 2022--"Protecting Youth Mental Health: Part I--An Advisory and Call to Action." Testimony was heard from Hon. Vivek H. Murthy, M.D., M.B.A., Surgeon General, Office of the Secretary, Department of Health and Human Services, Washington, DC.

February 15, 2022--"Protecting Youth Mental Health: Part II-- Identifying and Addressing Barriers to Care." Testimony was heard from Trace Terrell, Lead Intervention and Outreach Specialist, YouthLine, La Pine, OR; Tami D. Benton, M.D., psychiatrist-in-chief, executive director, and chair, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA; Jodie L. Lubarsky, M.A., LCMHC, vice president of clinical operations, Youth and Family Services, Seacoast Mental Health Center, Inc., Portsmouth, NH; and Sharon Hoover, Ph.D., professor, child and adolescent psychiatry, and co-director, National Center for School Mental Health, University of Maryland School of Medicine, Baltimore, MD.

March 16, 2022--"Prescription Drug Price Inflation: An Urgent Need to Lower Drug Prices in Medicare." Testimony was heard from Rena Conti, Ph.D., associate professor, Department of Markets, Public Policy, and Law, Questrom School of Business, Boston University, Boston, MA; Douglas Holtz-Eakin, Ph.D., president, American Action Forum, Washington, DC; Stephen J. Ezell, vice president, global innovation policy, Information Technology and Innovation Foundation, Washington, DC; and Steffany Stern, MPP, vice president of advocacy, National Multiple Sclerosis Society, Minneapolis, MN.

March 30, 2022--"Behavioral Health Care When Americans Need It: Ensuring Parity and Care Integration." Testimony was heard from John E. Dicken, Director, Health Care, Government Accountability Office, Washington, DC; Andy Keller, Ph.D., president and CEO, and Linda Perryman Evans Presidential Chair, Meadows Mental Health Policy Institute, Dallas, TX; Anna Ratzliff, M.D., Ph.D., co-director, Advancing Integrated Mental Health Solutions (AIMS) Center, and professor, University of Washington, Seattle, WA; and Reginald D. Williams II, vice president, international health policy and practice innovations, Commonwealth Fund, Washington, DC.

April 5, 2022--"The President's Fiscal Year 2023 Health and Human Services Budget." Testimony was heard from Hon. Xavier Becerra, Secretary, Department of Health and Human Services, Washington, DC.

Subcommittee on Health Care

2021

May 12, 2021--"The COVID-19 Pandemic and Beyond: Improving Mental Health and Addiction Services in Our Communities." Testimony was heard from Victor Armstrong, MSW, Director, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, North Carolina Department of Health and Human Services, Raleigh, NC; Stephanie Woodard, Psy.D., Senior Advisor, Division of Public and Behavioral Health, Nevada Department of Health and Human Services, Carson City, NV; Lenette Kosovich, R.N., MHA, chief executive officer, Rimrock Foundation, Billings, MT; and Malkia Newman, team supervisor, CNS Healthcare Anti-Stigma Program, Waterford, MI.

Subcommittee on Fiscal Responsibility and Economic Growth

2022

February 2, 2022--"The Hospital Insurance Trust Fund and the Future of Medicare Financing." Testimony was heard from Michael E. Chernew, Ph.D., Chair, Medicare Payment Advisory Commission, Washington, DC; Susan Rogers, M.D., FACP, president, Physicians for a National Health Program, Chicago, IL; Amy Kapczynski, professor and faculty co- director, Global Health Justice Partnership and Law and Political Economy Project, Yale Law School, New Haven, CT; Katherine Baicker, Ph.D., dean and Emmett Dedmon professor, Harris School of Public Policy, University of Chicago, Chicago, IL; and James C. Capretta, senior fellow and Milton Friedman chair, American Enterprise Institute, Washington, DC.

(Continues with Part 4 of 7)

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The report is posted at: https://www.congress.gov/congressional-report/118th-congress/senate-report/4/1?s=1&r=4

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